Shoulder Elbow Flashcards by Ravi Patel

Humeral Head offset

Axis is 7-9mm lateral and 2-4mm anterior to center of head

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incidence of FT cuff tears in RhA

25-40%

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what motion is lost the most in Shoulder oA

Ext Rot

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max amoun of eccentric reaming in glenoid

5mm or 15 degrees

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adv to superior approach to TSA

reflect anterior deltoid off acromium - down side is humeral access Is worse, but great A-P glenoid access

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how much Pec can be released

up to 1cm of superior pec

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humeral head cut in TSA

leave 2-3mm medial to cuff insertion; OR just anterior to bare spot –> restores native version

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stages of rehab in Scapular dyskinesia

full scapular motion and coordinating with trunk/hips (tx proximal to distal); then strengthen the scapular muscles

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Scapular Dyskinesis pathology

stress on anterior capsule and posterosuperior labrum - > leads to labrum or cuff tears

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Shoulder primary OA vs Inflammatora OA

Inflamm OA has more central wear and medial joint line; may have to resort to hemi bc no glenoid stock

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HIGHEST risk factor for non-healing RCT

age > 65

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UCL Elbow Bundles

Ant bundle is isometric in full ROM; Post bundle is longer in Flexion - changes the most from Ext to Flexion;

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Lateral elbow ligament

radial band is isometric; lateral Ulnar collateral is lax in extension

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internal impingement

seen in throwers; infra and posterior parts of supra get beat up during late cocking - can also have posterior superior labrum tears

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what position to avoid after SLAP repair

ER at 90 Abduction

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laterjet is most effective at which postion

60 of abduction

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when can you being sport specific rehab after SLAP

8-12 weeks post-op

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which lateral elbow ligament is most important

lateral ULNAR Collateral - the anterior band of this prevents valgus instability

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next step after painful hook test for biceps rupture

MRI to confirm partial vs complete

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what is bufford complex

cordlike MGHL with ABSENT Ant labrum - not the same as sublabral foramen

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elbow ligament origins on humerus medial vs lateral

medial ligaments origin on EPI-condyle; lateral ligaments on CONDYLE

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course of median nerve

lies MEDIAL to brachial artery in arm until elbow; runs on TOP of brachialis

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stryker notch vs west point views

SN is for Hill Sachs; WP is for anterior glenoid bone loss

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best MRI view for fatty degen of cuff

T1 sagittal at base of coracoid

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advantage of US for cuff tear and re-tear

it_s a dynamic study - can help distinguish b/w scar and cuff

threshold for converting partial tears to FT

if Articular > 6mm; if bursal > 3mm

incidence of HAGL

in unstable shouilders - 7-9%

ALPSA

anterior labrum,GHL and periosteum are stripped and retracted medially

long thoracic nerve roots

C5-6-7

medial winging resolution

usually by 24 months they resolve

AC joint capsule strength

superior capsule provides 50% of strength for AP translation; post capsule is about 25%

percentage of RCR that do NOT heal

50% - does not appear to affect outcomes

Degen vs Acute Scubscap tears

Acute subscap tears can involve more of tendon with retraction, where as DEGEN tears are superior fibers

post-op SLAp at 12 weeks

full ROM and strength

Secondary scapular winging

due to glenohumeral or acromial pathology -NOT from LT nerve injury - resolves after primary pathology is addressed

Shoulder OA capsule response

anterior capsule gets tight, posterior capsue gets redudant - lose Ext Rot

reccurence rates of shouler instability based on age

if < 20y 90%; if 20-40 then 60%; if > 40 then < 10%

incidence of RCT w/ shoulder dislocation

if 40-60 then 30%; if > 60 then 80%

associated fracture with dislocation

if > 50y a/w GT frx

primary POSTERIOR stabilizers of shoulder

SGHL, post band of IGHL, and CH lig

exam of post shoulder dislocation

prominent coracoid, limited Ex Rot, may have compensatory scapular winging

m/c complication of surg for post shoulder instability

Recurrence (7 to 50%); other complication can be stifness and adhesive capsulitis

2 classic lesions of MDI

big pouch inferior capsule; deficient rotator cuff

cuff tendonitis/impingment in pt < 20 years - worry about.

Multidirectional instability

preganglionic brachial plexus palsy

flail arm caused by ROOT avulsions

os acromiale types

pre (in front); meso (middle), meta (base/In back)

role of CA ligament

via CH ligament it prevents anterior and inferior GH translation

lateral vs medial scapular winging

lateral - spinal accessory n (top of scapula is prominent); medial - long thoracic (inferior border is prominent)

shoulder pain after ball release

tears of supra or infra due to eccentric loading during arm deceleration

eden lange procedure is

using levator scap; rhomboids to compensate for non functional trapezius and to fix lateral scapular winging

nerve roots of long thoracic nerve

C5-6-7

contraindication to lat dorsi transfer

subscap deficiency - poor outcomes

role of elbow flexors during decel

prevent elbow hyperextension

Connolly and Neer-McLaughlin procedures

Infra and GT transfer into Hill Sachs (Connolly) and Subscap and LT transfer into Reverse Hill Scahcs (N-M)

where does biceps attach in glenoid

70% is posterior labrum; 25% is middle labrum

ant vs post band of elbow and stiffness

post band is more variable in length throughout arc of motion - release in elbow contractures

diff b/w MGHL and SGHL in scope view

MGHL runs below the border of subscap - basically crosses over it

type 2 AC injury

AC out, CC are partially injured - non-op injury

m/c complication of 2 incision biceps

LABC nerve palsy

scapular movement during throwing

retracts during late cocking; protracts duing accel (due to serratus via long thoracic nerve)

bennet lesion in throwers

mineralization of the posterior inferior capsule from traction injury in throwers

does post shoulder tightness or GIRD improve symptoms

fixing post shoulder tightness by 7 weeks improves symptoms - imrpoving GIRD does not

static progressive elbow splinting used for

flexion contracture >30 deg or inability to get more than 130 deg

how to do jerk test for Kim lesions

FF to 90; internal rotation to shoulder; then axial load in posterior direction - a clunk will be felt as arm moves into extension and reduces

stages of calcific tendonitis

pre-calcific (metaplasia of tenocytes into chondrocytes); calcific stage with 3 subtypes (formative, resting, resorptive)

two types of calcific tendonitis

Type 1 is fluffy on XR and is acute, painful, usually during formative phase; type 2 is more subacute/chronic with discrete mineralization

pec vs subscap and insertion on LT

pec inserts LATERAL to biceps tendon

best MRI for pasta tears

MR arthrogram in ABER position - takes tension off cuff so contrast can fill the space

what position is arm after post shoulder dislocation

fixed in IR - wont externally rotate due to engagement of ant humeral head on posterior glenoid

thoracic outlet syndrome affects what

subclavian aa/vein and LOWER trunk (C8-T1) - ulnar nerve (ring, little finger and intrinsics)

injury to posterior branch of axillary nerve affects

lateral shoulder sensation and terres minor weakness

percentage of pts over 60 with RCT AND OA

less than 10%